Some Signs, Symptoms of Acute and Chronic
Renal/Kidney Failure
Acute Kidney Failure:
- Vacillating amounts of urine elimination, sometimes normal, sometimes less than normal;
- Legs, ankles and feet may swell due to the build up of fluid within the body;
- Feeling sleepy;
- Difficulty breathing;
- Lack of energy; and,
- Perhaps chest pain in more advanced cases
(Mayo Clinic Staff, Mayo Clinic website, May 13, 2008).
Chronic Kidney
Failure:
- Blood pressure increases significantly;
- Urine elimination decreases or ceases;
- Urine
color is abnormal;
- Client may be anemic;
- Appetite diminishes;
- Regurgitation and queasiness;
- Shift in weight;
- Generally just doesn't
feel well;
- Presence of headaches that have no etiology;
- Difficulty sleeping;
- Thinking may be sluggish;
- Presence of pain in the kidney areas;
- Problems
with muscles;
- Feet and ankles are swollen;
- Abnormal stools;
- Change in skin color; and
- Tenacious itching (Mayo Clinic Staff, Mayo Clinic website, May 13, 2008).
Finally, eating disorders are a catalyst for massive, internal damage. They are serious matters
and ignoring them will lead to complications. Instead of a state of balance, eating disorders throw the body into an imbalanced
state, creating a ripple of consequences that can become life threatening. Kidney failure is only one possibility.
Electrolyte Imbalances and Laxatives
Abusing
laxatives can be fatal. Laxatives can induce hypokalemia, an abnormally low potassium level in the blood, which
may lead to electrolyte imbalances. Misusing diuretics and self-induced vomiting also increase the risk of electrolyte imbalances.
Electrolytes are dissolved minerals used by the body to conduct electricity. Potassium,
sodium and calcium are all important for proper electrolyte balance. Laxatives, diuretics, and other purging techniques
prevent the body from maintaining a proper level of electrolyte minerals.
Electrolytes
are vital for proper electric signals in the heart. One of the most serious dangers of electrolyte imbalance in bulimia is
heart arrhythmia (irregular heartbeat). A heart problem is not only one of the dangers of bulimia; it is a leading
cause of death associated with bulimia nervosa.
Electrolytes are salts that conduct electricity and are found in the body fluid, tissue, and blood. Examples are
chloride, calcium, magnesium, sodium, and potassium. Sodium (Na+) is concentrated in the extracellular
fluid (ECF) and potassium (K+) is concentrated in the intracellular fluid (ICF). Proper balance is essential
for muscle coordination, heart function, fluid absorption and excretion, nerve function, and concentration.
The kidneys regulate fluid absorption and excretion and maintain a narrow range
of electrolyte fluctuation. Normally, sodium and potassium are filtered and excreted in the urine and feces according to
the body's needs. Too much or too little sodium or potassium, caused by poor diet, dehydration, medication, and disease,
results in an imbalance. Too much sodium is called hypernatremia; too little is called hyponatremia. Too much potassium
is called hyperkalemia; too little is called hypokalemia.
Incidence
and Prevalence
Hyponatremia is the most common electrolyte imbalance.
It is associated with kidney disease such as nephrotic syndrome and acute renal failure (ARF). Men and women with healthy
kidneys have equal chances of experiencing electrolyte imbalance, and people with eating disorders such as anorexia and
bulimia, which most often affect women, are at increased risk. Very young people and old people are affected more often
than young adults.
Hyponatremia
Causes
Hyponatremia
is caused by conditions such as water retention and renal failure that result in a low sodium level in the blood.
Pseudohyponatremia occurs when too much water is drawn into
the blood; it is commonly seen in people with hypoglycemia (low blood sugar).
Psychogenic polydipsia occurs in people who compulsively drink more than four gallons of water a
day.
Hypovolemic hyponatremia (with low blood volume
due to fluid loss) occurs in dehydrated people who rehydrate (drink a lot of water) too quickly, in patients taking thiazide
diuretics, and after severe vomiting or diarrhea.
Hypervolemic
hyponatremia (high blood volume due to fluid retention) occurs in people with liver cirrhosis, heart disease, or
nephrotic syndrome. Edema (swelling) often develops with fluid retention.
Euvolemic hyponatremia (decrease in total body water) occurs in people with hypothyroidism, adrenal
gland disorder, and disorders that increase the release of the antidiuretic hormone (ADH), such as tuberculosis, pneumonia,
and brain trauma.
Signs and Symptoms
Symptoms of hyponatremia are related to the severity and the rate at which the conditions develop. The first
symptoms are fatigue, weakness, nausea, and headache. More severe cases cause confusion, seizure, coma, and death.
Treatment
The
goal of treatment is to restore electrolyte balance for proper hydration and use of total body fluid. Sodium deficiency
must be corrected slowly because drastic change in sodium level can cause brain cell shrinkage and central pontine myelinolysis
(damage to the pons region of the brain). Methods include:
- Fluid
and water restriction
- Intravenous (IV) saline solution of 3% sodium
- Salt tablets
Conivaptan (Vaprisol®)
has been approved by the U.S. Food and Drug Administration (FDA) to treat hypervolemic hyponatremia and euvolemic hyponatremia
in some hospitalized adults. Vaprisol is administered intravenously (i.e., into a vein). Blood sodium levels should be closely
monitored in patients who receive this medication. Side effects include injection site reactions, headache,
thirst, and low potassium levels.
Hypernatremia
Hypernatremia is high sodium in the blood that occurs with excessive fluid loss.
When fluid is lost and not replaced, sodium is not adequately excreted from the body.
The following are causes:
- Diabetes insipidus (caused by deficiency of or insensitivity to ADH)
- Diarrhea
- Diuretic medication
- Excessive salt intake
- Excessive vomiting
- Heavy respiration (e.g., exercise, exertion)
- Severe
burn
- Sweating
It is associated with the same symptoms as hyponatremia,
and also causes the following:
- Delerium
- Irritability
- Muscle twitching
Hypernatremia commonly affects older hospitalized people, 50% of whom have underlying diseases that, when combined
with excessive sodium and fluid loss, are fatal.
Treatment
Treating hypernatremia involves slowly replenishing water loss, usually over
48 hours, through drinking or intravenous (IV) solution. In cases of diabetes, the imbalance is treated with adequate water
intake and nonsteroidal anti-inflammatory drugs or with synthesized hormones (e.g., desmopressin) that aid in fluid retention
and decrease urination.
Some drugs used to treat electrolyte imbalance
may be unsafe for pregnant women and should not be taken before consulting a physician.
Hypokalemia
An abnormally low level of potassium
(K+) is called hypokalemia. The adrenal gland makes a hormone (aldosterone) that signals the kidneys to excrete or conserve
potassium, based on the body's needs. In hypokalemia, the adrenal gland retains the hormone and the kidneys conserve potassium
when more is needed.
Causes
The most common cause of potassium depletion is diuretic medication
that increases urination. Diuretics are prescribed for medical conditions and are used in weight-loss programs. Other causes
include:
- Diarrhea
- Dietary
deficiency
- Excessive sweating
- Magnesium deficiency (causes overexcretion of fluid)
Signs
and Symptoms
Symptoms of deficiency include cardiac arrhythmia,
muscle pain, general discomfort or irritability, weakness, and paralysis.
Diagnosis
Diagnosis may require urinalysis and blood tests to determine the amount of potassium
being excreted by the kidneys.
Treatment
Treatment involves potassium supplements, proper diet, and intravenous (IV) solution.
The best way to maintain an adequate potassium level is to eat foods such as sweet potatoes, bananas, avocados, spinach,
and oranges. Patients taking diuretic medication are also given potassium supplements. Potassium is given slowly to avoid
hyperkalemia.
Hyperkalemia
An abnormally high level of potassium is called hyperkalemia. Potassium is released into the blood when cells
are damaged.
Causes
Conditions that cause hyperkalemia include:
- Burns
- Chemotherapy
- Hemolysis (red blood cell
destruction caused by infection or burn)
- Rhabdomyolysis (destruction of
skeletal muscle; associated with acute tubule necrosis, or ATN)
- Strenuous
exercise (rarely)
Urinary excretion of potassium can be impaired
by the following:
- Acute renal failure (ARF)
- Chronic renal failure (CRF)
- Impaired aldosterone release or production
- Medications that decrease potassium excretion:
- Amiloride
(diuretic)
- Bactrim® (antibiotic)
- Cyclosporine (immunosuppressive)
Signs and
Symptoms Hyperkalemia affects the heart and causes electrocardiogram
(EKG) changes, ventricular fibrillation, and cardiac arrest. Other symptoms include tingling in the extremities, weakness,
and numbness.
Treatment
Treatment of low-grade hyperkalemia may involve diuretics and calcium given intravenously to promote potassium
excretion. Insulin is given with glucose to help cell absorption of potassium, and albuterol may be added to increase absorption.
Drugs that bind to potassium, such as Kayexalate®, force potassium into the intestine to be excreted.
Some drugs used to treat electrolyte imbalance may be unsafe for pregnant women and should
not be taken without consulting a physician.
Definition of Kidney
Kidney: One of a pair of organs located in the right and left side of the
abdomen which clear "poisons" from the blood, regulate acid concentration and maintain water balance in the body
by excreting urine. The kidneys are part of the urinary tract. The urine then passes through connecting tubes called "ureters"
into the bladder. The bladder stores the urine until it is released during urination.
The kidneys remove waste products from the blood and produce urine. As blood flows
through the kidneys, they filter waste products, chemicals, and unneeded water from the blood. Urine collects in the middle
of each kidney, an area called the renal pelvis. Urine then drains from the kidney through a long tube, the ureter, to the
bladder, where it is stored.
The kidneys also make substances that help
control blood pressure and regulate the formation of red blood cells.
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